Labor & Delivery HBsAg Admission for hospital inpatient information Checklist for Birthing Mother For your answers, please check “yes” or “no,” and add check marks and your initials where indicated. step 1

Check new patient’s B status yes no rn init Was the recommended test ordered, i.e., HBsAg (not antiHBs, HBsAb, antiHBc, HBcAb)? Was the test result obtained during this pregnancy (and not from an earlier pregnancy)? Is there a copy of the original HBsAg lab report in the prenatal record (not a transcribed test result)? A ▲ If any question above is answered “no,” fill out ▲ If any question in Step I or 2 chart A at right, and then proceed to Steps 2 and 3. when done, indicates immediate need add check rn init step 2 for HBsAg screening, do the Spoken introduction for this section, if it is helpful: While the questions I am following: about to ask may feel unnecessary or intrusive, we ask them of ALL our patients. Draw surface antigen We ask because if there is even a chance you might have been unknowingly exposed (HBsAg) test from mother STAT. to the at any time during your pregnancy, we need to know so we Verify with the lab that they will call can protect your baby from becoming infected with this very serious disease. We L&D and nursery with the STAT HBsAg hope you understand. test result as soon as it is available. Screen new patient for hepatitis B risk Notify the responsible nursery nurse yes no rn init that the HBsAg test result is pending. factors during this pregnancy Contact the lab if the test result is not Have you had hepatitis (e.g., skin or eyes turned yellow) back by the expected time. since your previous hepatitis B test? Notify the responsible nursery nurse Have you had sex with a person who is HBsAg-positive? that if HBsAg results are still pending Have you injected illegal drugs during this pregnancy? 12 hours after birth, the infant should immediately be administered post- Have you had more than one sex partner in last 6 months? exposure prophylaxis based on infant’s Have you been evaluated or treated for a sexually birth weight: transmitted infection during this pregnancy? • <2,000 grams administer HBIG and ▲ If any question above is answered “yes,” fill out . ▲ chart A at right, and then proceed to Step 3. • ≥2,000 grams administer hepatitis B step 3 vaccine.

▲ Be sure to complete Steps 2 and 3. not when done, If HBsAg test result is positive rn init (whether STAT or routine): applicable add check Alert nursery staff that the newborn is high risk signature(s) and will need postexposure prophylaxis with hepatitis B immune globulin (HBIG) and hepatitis B vaccine within 12 hours of birth. nurse signature date and time Educate mother that her baby is at risk for HBV transmission at birth and will need: nurse signature date and time • Prophylaxis beginning within 12 hours of birth and continuing through until the HepB vaccine nurse signature date and time series is completed. • Lab work after HepB series is completed to determine if infant is infected with HBV. • Referral of mother and infant to Perinatal Hepatitis B Prevention Program for follow up. Provide mother with language-appropriate informa- Immunization Action Coalition tion about hepatitis B treatment and prevention. Saint Paul, Minnesota • 651-647-9009 Notify your Perinatal Hepatitis B Prevention www.immunize.org • www.vaccineinformation.org Program of birth to HBsAg-positive mother. www.immunize.org/catg.d/p2225.pdf • Item #P2225 (3/20)